GI - Other Gastric Neoplasms

Question 1

Identify 5 benign and 3 Malignant Gastric neoplasms

Answer 1

• Benign: Benign polyps (adenomas), leiomyoma, lipomas, haemangiomas, schwannomas
• Malignant: lymphoma, carcinoid, GIST

Question 2

Gastrointestinal stromal tumour (GIST): pathophysiology

Answer 2

• Commonest mesenchymal tumour in GIT, >50% occur in stomach
• Alice from intestinal cells of Cajal (pacemaker cells within bowel wall, located in muscularis propria)
• OGD visualisation: well-demarcated spherical mass with central punctum

Question 3

Gastrointestinal stromal tumour (GIST): presentation and poor prognostic factors

Answer 3

• Presentation: mass effects (abdo pain, obstruction) and ulceration (bleeding)
• Poor factors: big size, extra-gastric location, high mitotic index

Question 4

Gastrointestinal stromal tumour (GIST): Mx - medical and surgical

Answer 4

• Medical: if unresectable, recurrent or metastatic disease - can give Imatinib (kit selective tyrosine kinase inhibitor)
• Surgical: resection

Question 5

What are carcinoid tumours?

Answer 5

• Diverse group of neuro-endocrine tumours of enterochromaffin cell origin
• May secrete multiple hormones
• 10% occur in stomach

Question 6

What occurs with gastric carcinoids?

Answer 6

-Pt has atrophic gastritis —> decreased acid production —> increase in gastrin —> ECL hyperplasia —> carcinoid tumour

Question 7

What is a gastric lymphoma?

Answer 7

• Commonest site for extranodal lymphoma
• most commonly a MALToma due to chronic H pylori gastritis
• H pylori eradication can be curative

Question 8

Zollinger-Ellison Syndrome: pathophysiology

Answer 8

• Gastrimona most commonly found in small intestine or pancreas
• Increased gastrin —> raised HCL = PUD and chronic diarrhoea
• 60-90% of gastronomes are malignant
• 25% are associated with MEN1

Question 9

Zollinger-Ellison Syndrome: presentation

Answer 9

• Abdo pain/dyspepsia
• Chronic diarrhoea/dyspepsia
• Refractory PUD

Question 10

Zollinger-Ellison Syndrome: Ix

Answer 10

• Raised gastrin associated with raised HLC (pH<2 in stomach)
• MRI/CT
• somatostatin receptor scintigraphy

Question 11

Zollinger-Ellison Syndrome: Rx

Answer 11

• High dose PPI (60mg BD)

- Surgery: tumour resection or subtotal gastrectomy with Roux-en-Y